Reflective inquiry in nursing practice or 'revealing images'

Reflective inquiry in nursing practice or 'revealing images' Nurses live and work in complex practice worlds; worlds of shrinking resources and expanding needs. Reflection through journaling offers unique opportunities to gain insight into practice. What might we learn from one's journal? A reflective journal can be a source of interplay between the self as written and the self as other. Likewise, the journal may act to situate ourselves in practice, while at the same time enabling us to illuminate how and in what ways our understandings have become distorted. The extent to which one's journal is educative depends upon the manner in which one chooses to use it as a transformative tool, a tool that might well be described as a process of healing and enlightenment. In order to illustrate the reflexive nature of journaling, this paper is presented as a play reading, where a conversation about practice stories between the different aspects of the nurse's self is depicted. In adopting a play reading, an alternative pedagogical tool is used to illustrate different methodologies exemplifying the emergence of how and in what ways we develop and reconstruct our understanding in nursing.     

The ‘limits’ of medicalization?: Modern medicine and the lay populace in ‘late’ modernity

Taking as its point of departure the medicalization thesis and its limitations, this paper provides a critical discussion of certain more recent theoretical perspectives on life in contemporary society, and their relevance for understanding the relationship between modern medicine and the lay populace. In particular, attention is paid to the contours and existential parameters of life in ‘late’ modernity in terms of the following four key themes: (i) modernity as a ‘reflexive’ social order; (ii) ‘risk’ and the dialectic of scientific and social rationality; (iii) the ‘mediation’ of contemporary experience; and (iv) lay ‘re-skilling’ and the ‘life political’ agenda. On the basis of this, it is argued that far from being simply passive and dependent, a ‘critical distance’ is beginning to emerge between modern medicine and the lay populace; a situation which resonates with broader social trends and currents within society at large.     

A gambler called “Steel Balls”

“Steel Balls” is the nickname of a New Zealand gambler who gained considerable notoriety through his widely publicized gambling exploits. In some media reports, he is quoted admitting to be a “problem gambler” requiring the help of psychologists and similar experts. At other times, he tells the media he is in control of his gambling, and would like to be left alone to pursue the (controlled) level of gambling he enjoys. Such variation in what people say and do is common, but we need to be careful in how we deal with this in our academic analyses. The case is made for the study of gambling to consider the important entanglements of language, self-identity, and social action. The work of Hacking on “looping effects” and “interactive kinds” is applied to the Steel Balls nickname, and to offer broader implications for the understanding of problem gambling.     

Thinking critically about client-centred practice and occupational possibilities across the life-span

Abstract

Background: Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are “normal” occupational possibilities. These values and beliefs privilege some occupations and negate others. Aim: This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice. Methods: Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered “normal” occupations and how these taken-for-granted values structure occupational therapy practice. Conclusion: Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients’ predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of “normal’.     

去除外膜对血管内膜增殖及反应性的影响

目的:观察去血管外膜后兔颈动脉血管内膜增殖及血管反应性改变的情况。方法:在体去除兔颈动脉外膜,于术后0周及1周时取出动脉作组织学检查,血管张力测试,免疫组织化学染色,用RT-PCR法测定返原型辅酶Ⅱ氧化酶P22亚单位(NADPH Oxidase P22Phox)信使核糖核酸(mRNA)。结果:(1)外膜去除方法对血管内皮及中层平滑肌无明显损伤;(2)外膜去除后血管内膜增生,增生成分为血管平滑肌细胞;(3)与完整外膜血管比较,去外膜血管对去甲肾上腺素(NE)的收缩反应在术后即刻及1周均减弱(P<0.05),对乙酰胆碱(Ach)的舒张反应在术后即刻增强(P<0.05);(4)与完整外膜血管比较,去外膜血管NADPH Oxidase P22Phox在1周时表达增高(P<0.05)。结论:外膜去除可致兔颈动脉内膜增生,同时引起血管舒缩反应性发生改变。     

Rethinking ethnography: reconstructing nursing relationships

AIMS OF THE STUDY: Critical ethnography is being adopted increasingly by nurses as a legitimate form of research methodology. This paper explores the research practices and dilemmas that emerge from this methodology using a recently completed ethnographic study of nurse-nurse and nurse-doctor interactions in a critical care hospital setting. BACKGROUND: Critical ethnography provides a useful methodology that facilitates mutual dialogue among participants. It may be limited, however, by the central role of researchers and by a tendency to negotiate participants' realities according to a particular 'truth'. These concerns have been strongly critiqued by poststructuralists using concepts such as discourse, subjectivity and power. By incorporating the notion of a poststructural analysis into critical ethnography, researchers are in a position to examine critically the tensions in their own practices, and their struggles with documenting and analysing ethnographic accounts. DESIGN: Six registered nurses comprised the participants of the research group. Through the method of professional journalling, the first author of this paper explored her professional interactions with doctors and other nurses in her role as a nurse in the critical care setting under investigation. Other methods included participant observation, and individual and focus group interviews with nurse participants. ISSUES OF METHODOLOGICAL CONCERN: This paper considers three issues of methodological concern: researcher/participant subjectivity; the movement from empowerment to reflexivity and the construction of one form of ethnographic 'truth'. These issues are discussed in reference to the research relationships with the nurse participants and the process of analysing ethnographic accounts. CONCLUSIONS: In working with critical ethnography using a poststructural analysis, we were able to generate valuable insights about previously hidden areas of relationships among nurse participants in a research group during all stages of the research process. It also provided a means of informing the analysis of ethnographic texts.     

Knowledge generation and utilisation in occupational therapy: Towards epistemic reflexivity

Aim:  The purpose of this article is to consider the ways in which theory generation, and hence knowledge generation, in occupational therapy is a complex social process, and therefore carries (often hidden) responsibilities for those who are part of our epistemic community. An epistemic community is a knowledge-producing community, who apply their standards of credibility, and epistemic values, to theory choice. In occupational therapy this community is comprised of a worldwide group of scholars and practitioners.
Methods:  We propose that epistemic reflexivity can be used to critique and contribute to our disciplinary knowledge and to critically consider 'who' makes epistemological choices in our profession, and the consequent implications for the theories we adopt. The purpose of this article is to make these relations explicit so that scholars and therapists can become increasingly conscious and empowered with respect to their contributions to occupational therapy's epistemic community. To demonstrate an application of epistemic reflexivity, we critically consider a theoretical construction that has been widely adopted by the international occupational therapy community: evidence-based practice.
Results:  As authors, we engage in epistemic reflexivity to critically consider the challenge posed by evidence-based practice. We propose a conception of practice knowledge that is informed by evidence yet based on a conception of wise practice.
Conclusion:  Our intention is to stimulate discussion and debate in occupational therapy's epistemic community, a number of approaches for fostering epistemic reflexivity in occupational therapy are suggested.